Provider Demographics
NPI:1861419434
Name:LING, SHIRAT (DO)
Entity type:Individual
Prefix:
First Name:SHIRAT
Middle Name:
Last Name:LING
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-3046
Mailing Address - Country:US
Mailing Address - Phone:512-656-5464
Mailing Address - Fax:834-300-6522
Practice Address - Street 1:1611 S 1ST ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-3046
Practice Address - Country:US
Practice Address - Phone:512-656-5464
Practice Address - Fax:844-300-6522
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2022-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41938207Q00000X
TXL1372207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH60000Medicare UPIN